Oral Concurrent Session 3 - Fetus and Fetal Intervention
Oral Concurrent Sessions
Ramen H. Chmait, MD (he/him/his)
Director, Los Angeles Fetal Surgery; Professor, Department of Obstetrics and Gynecology
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Lisa M. Korst, MD, PhD
Childbirth Research Associates
North Hollywood, California, United States
Arlyn S. Llanes, MHA, RN
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Moshe Fridman, PhD
AMF Consulting
Los Angeles, California, United States
Adam Beasley, MD
Children's Hospital Los Angeles
Los Angeles, California, United States
Douglas L. Vanderbilt, MBA, MD, MS
Children's Hospital Los Angeles
Los Angeles, California, United States
For twin-twin transfusion syndrome (TTTS) patients who underwent fetoscopic laser surgery, we hypothesized that a rise in the postoperative middle cerebral artery peak systolic velocity multiples of the median (MCA-PSV MoM) would later be associated with lower Battelle Developmental Inventory 2nd Edition (BDI-2) scores because acute fetal blood loss may lead to developmental abnormalities.
Study Design:
In this retrospective cohort study of laser-treated TTTS patients, the change in fetal MCA-PSV MoM (Delta) was calculated as the postoperative (~24 hours after laser surgery) minus preoperative value; a positive Delta signifies a postoperative rise (suggestive of acute blood loss). The outcomes were the Total BDI-2 score (BDI Total) and the individual domain scores (ie, Adaptive, Cognitive, Communication, Motor, Personal/Social) at 2 years of age, standardized to a mean (SD) of 100 (15). For each outcome, patient characteristics were tested independently in multilevel linear regression models to identify relevant covariates; backward elimination was then applied to the full model.
Results:
BDI-2 evaluation was conducted for 99 children (56 families), with median (range) for BDI Total 101 (58 to 132), BDI Motor 108 (55 to 127), and Delta 0.020 (-0.84 to 0.78). In bivariate analysis with the outcome BDI Total, the regression coefficient (β) for the Delta was β=-5.21 (-12.25 to 1.82), P=.144; upon adjustment, β=-6.84 (-13.60 to -0.07), P=.048 (ie, for every 0.1-point increase in Delta, the BDI Total score dropped 0.7 points) (Table 1). The Delta was associated with the Motor domain: β=-8.98 (-15.61 to -2.36), P=.009; upon adjustment, β=-10.18 (-16.25 to -4.12), P=.001 (ie, for every 0.1-point increase in Delta, the BDI Motor score dropped 1.0 points) (Table 2).
Conclusion:
A rise in the postoperative MCA-PSV MoM was associated with a score decrease in the total BDI, and specifically, the Motor domain scores. Further exploration of this relationship appears warranted.